Diseases in roleplaying games

Earlier that week I have been coping with a nasty cold. My head felt like someone smashed it with a sledgehammer, I was freezing all the time, overall I felt awful. And don’t get me started on the coughing, sneezing and my running nose. When I got a bit better, it actually got me thinking about diseases in roleplaying games.

But much like poisons, diseases don’t usually have a big impact on roleplaying games. In most high fantasy games everything that doesn’t kill you immediately is just a minor nuisance. D&D for example knows a couple of spells that can easily heal any disease and even resurrecting the dead is just a question of how much you can pay.

But in other settings diseases can actually be used to make things much more interesting. Even infecting the player characters with some nasty bug can add to the game if done well. Of course this only works when the disease doesn’t render the characters totally helpless and if there’s some chance to get healed.

In my opinion your fantasy world gets much more interesting when you add some more realism to it. In medieval times people lived in pretty bad conditions. Hygiene was often an alien concept, people lived extremely close together and diseases that are easily cured in our modern world, have been real killers back then. But in most quasi-medieval fantasy worlds everything is clean, people don’t seem to get sick and even if they do, the village priest knows a spell to fix everything.

I am always overjoyed when I read a roleplaying game rulebook that lists some diseases you can actually use. Too often than not diseases are too deadly too fast to actually be used on the player characters. If you get killed by a bugbear in a fight it’s one thing, but it’s just no fun when you die and turn into a nasty demon because of Nurgle’s Rot. Warhammer Fantasy Roleplay 1st Edition I am looking at you here!

So how can you add diseases to a game effectively? That’s a question I keep pondering, but I haven’t found a solution I am 100% content with. I’ve used diseases in games before. Usually I use sicknesses and plagues as a backdrop, much like I sometimes use wars. The players themselves are not directly afflicted by it, but the world around them is. City quarters are quarantined because of some outbreak of the black plague, people are fleeing from their homes to avoid getting infected, etc.

When you want to affect the players with diseases themselves, you need to think about what effects the disease has on their skills and abilities. In games like FATE you could use a temporary Aspect that lasts until the character has been healed. In other games the symptoms may cause negative modifiers on skill or attribute rolls.

An ambitious GM may even do some research on real sicknesses and try to emulate the effects in the roleplaying game or may invent some fictitious ones. Even a simple cold should have some major effect on the combat effectiveness of the players, or have you ever tried solving riddles with a splitting headache? Whatever you do, try to use diseases as a way to make the game more immersive, more “real”, and don’t just use the effects of some sickness to make the life miserable for the players. The game should still be fun.

What is your opinion on using diseases in roleplaying games? Love ‘em or hate ‘em? Is there a game that handles diseases really well? Or do you know some of the very bad examples? Please share your comments below!

4 thoughts on “Diseases in roleplaying games”

A PC unleashed the plague upon a city. As you said it is pretty difficult to affect the PCs with this disease as their saves are high, vast amounts of magic at their disposal and spells to bring them back from the dead if things did go really bad for them.

But bringing it to a mass number of people overwhelms even their resources, so it played out pretty well in my campaign.

I struggled with creating detailed lists of diseases for The Artifact because I wanted the threat of disease to play a role but it took up way too much space. Instead I set up a system that randomly generates a disease.

There were a few things that a random disease generator needs.
1. It has to have a list of conditions where a character could pick up a disease. They have to be relatively predictable so the GM knows when to apply them and if not in a dark ages setting the players may have a chance of avoiding getting sick.
2. You have to know where the disease comes from. If you grew up being exposed to a local disease, you should have more resistance to it.
3. The disease should phase in over time.

I also figured it was better for the GM to figure out the onset of a disease at the end of a game rather than the start. One, it makes it a little more fair and predictable for the player. Two it prevents a slow start up explaining that a player got infected.

Pathfinder actually addressed this in one of their campaign chronicles. I believe it was the one called Seven Days to the Grave set in Korvosa. Anyway, they fully acknowledge this disparity in terms of disease between real life and RPGs, but they then go ahead with it anyway. The trick to it for them was not infinding something that would affect the PCs necessarily, though it very well could, but rather in creating a disease that would spread faster than it could be cured. They figured out an infection rate that outpaced the magical healing of clerics and paladins, as well as other magical means. The result was something horrific as players were forced to deal with their own preferential status as well as the mass of people infected seeking a cure. It’s probably one of the best attempts at disease in a fantasy RPG that I’ve seen.

I just stumbled upon your post, but I was searching for some ideas about using disease in role-playing games. I would say that as a GM I would not want to use diseases like a random encounter but as a consequence for actions that would naturally expose the players to disease (not necessarily only in the use of prostitutes or while pillaging if you allow that sort of thing). If the party wants to invade a castle through the sewer system, bacterial infections (fantastically horrific variations), viral infections, parasitic infections should be a possibility (roll against constitution). Diseases can also make for an interesting diversion to search for cures (complex formulas not unlike the search for spell components). Disease weapons aren’t out of the question, but it is more likely that attacking a swarm of wimpy trolls to increase experience points should result in minor injuries that should become vectors for major complications.

About the Author

Stargazer

Michael Wolf is a German games designer and enthusiast best known for his English language role-playing games blog, Stargazer's World, and for creating the free rules-light medieval fantasy adventure game Warrior, Rogue & Mage. He has also worked as an English translator on the German-language Dungeonslayers role-playing game and was part of its editorial team.

In addition to his work on Warrior, Rogue & Mage and Dungeonslayers, he has created several self-published games and also performed layout services and published other independent role-playing games such as A Wanderer's Romance, Badass, and the Wyrm System derivative Resolute, Adventurer & Genius, all released through his imprint Stargazer Games.

Professionally, he works as a video technician and information technologies specialist. Stargazer's World was started by Michael in August 2008.